Approaches and challenges in railway suicide prevention

This section describes preventive measures that may help reduce the risk for railway suicides. These measures have been described in the published literature or in unpublished reports. Some have been evaluated, others have only been described but not yet implemented or have been tried but never evaluated scientifically. Besides differences in the availability of scientific data proving their effectiveness, some measures may be more or less feasible in different countries and railway contexts. Prevention measures have been classified according to two dimensions which may be of use in choosing what is more appropriate in specific situations:

Technical – Psychosocial dimension:

This dimension describes the nature of the interventions in terms of their level of involvement of technology versus human resources. Interventions can be mostly technical, involving primarily equipment and the use of technological solutions. Interventions can also be primarily psychosocial, based on principles of psychological interventions that consider suicide attempts from a socio-behavioural perspective.

Purpose dimension:

We have divided potential objectives of the measures into three categories:

Preventing injury: This set of measures aims at reducing the physical risks once the suicidal gesture has been made

Preventing impact: These measures aim at stopping people from accessing the tracks when they intend to commit suicide

Preventing attempts: These measures aim at identifying at risk people and acting before they plan or carry out their suicide attempt

Each type of measure is described in terms of its background, components, implementation, studies of its effectiveness, efficiency, cost-effectiveness, and feasibility in Canada.

Dealing with the potential substitution of suicide methods

One of the frequent objections to the installation of measures to limit access to a suicide method, such as barriers in stations, is the concern that suicidal persons will choose other substitute methods. Within the railway context, this translates to the potential scenario that if not all stations have barriers, potential victims may simply go to stations where barriers have not been installed. If all tracks are not fenced, people will go where there is no fencing. However, a study by Law and colleagues in Hong Kong (2009) showed that between 1997 and 2007, when 30 of the 38 stations on the MTR Line had sealed doors installed on all platforms, but the remaining 8 MTR stations and all stations on the KCR network had no barriers, there was an overall reduction of 59.9% in suicides with no indication of substitution by potential attempters using the unprotected stations. This is an indication that if the access reducing measure is well planned and implemented in the proper high risk areas, there may be little or no substitution of method. Suicide attempts will not be displaced elsewhere. This phenomenon has been observed in several contexts, with many different suicide methods, such as limiting access to paracetamol and other analgesics, pesticides, bridges, high rise buildings, etc. However, there are some cases where displacement was observed. So far, those cases remain rare. Therefore research to date indicates that preventing access to a suicide method not only reduces suicides by that method, but can prevent suicides in general.

Challenges

All the methods shown in the figure above (and described in detail in the next section) can have varied effects depending on the context. For example, limiting access to tracks has proven very effective in high density areas and at hotspots where multiple suicides have occurred. However, it may not be feasible in low density railway networks.

Costs

Costs involved in railway prevention strategies are an important issue. Although it is impossible to put a price on a human life, the high costs of some prevention strategies make them difficult to justify and implement on a large scale.

Patterns

Railway suicides do not have similar patterns in all countries. Therefore, a prevention strategy that is effective in preventing suicide on platforms and in station will not be useful in a country where most suicides take place away from stations and on open tracks, as is the case in most of Canada. An in-depth analysis of the local patterns of railway suicides is needed before any strategy can be devised to fit the local context.

Hotspots

Hotspots are a common phenomenon that renders the implementation of a railway suicide prevention strategy easier because there are a large number of suicides in a small area. Thus, local actions at and near hotspots may save lives with relatively limited investments. However in some places there are no hotspots and even when there are hotspots, they only account for a limited number of suicides. Therefore, prevention measures that focus on hotspots, although effective in saving lives, only address part of the problem.

Evaluation of Effectiveness

For many railways, suicide remains a rare phenomenon with a small number of suicides per mile or kilometre of track. Therefore, evaluating the effectiveness of a suicide prevention strategy may be difficult. Natural variations in small frequency behaviours may make it difficult to isolate the effect of the prevention strategy and provide statistically significant proof of the effectiveness of prevention strategies, unless the research continues for many years. Differences in recording of railway suicides also make comparisons between countries hazardous. Even within a country, collection instruments for coroners and medical examiners are not always standardised and data are often not directly comparable. Finally, few research has evaluated the combined effect of interventions, despite the evidence that a muti-centred approach to suicide prevention is often more effective.

All these issues reduce the number of potential effective strategies to implement in a specific area that has been or can easily be validated by research. They increase the difficulty for those who want to implement and evaluate the effectiveness of railway suicide prevention. It also may be hazardous to implement strategies developed elsewhere without extensive previous analysis. Finally it often makes the evaluation of railway suicide prevention projects costly in resources and time.

However, these challenges should not stop railway stakeholder from developing and implementing ways to reduce the risks for railway suicide. Strategies can combine several activities to fit local characteristics. For example, a strategy may combine using barriers to prevent access to the tracks in a sensitive urban area with an intensive intervention, such as cameras and surveillance, with posters and dedicated telephone lines to a crisis centre, in the vicinity of a hotspot, as well as providing education to mental health professionals in less urbanised areas where few suicides occur. Local partners may also be involved to develop multi-faceted strategies including community awareness, gatekeeper training and support to reduce the number of walking paths close to tracks.